Incidence and prognostic significance of complete axillary downstaging after primary chemotherapy in breast cancer patients with T1 to T3 tumors and cytologically proven axillary metastatic lymph nodes
Incidence and prognostic significance of complete axillary downstaging after primary chemotherapy in breast cancer patients with T1 to T3 tumors and cytologically proven axillary metastatic lymph nodes
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DOI：
10.1200/jco.20.5.1304
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发表时间：
2002-03-01
影响因子：
45.3
通讯作者：
Bourstyn, E
中科院分区：
文献类型：
--
作者：
Rouzier, R;Extra, JM;Bourstyn, E
目的：确定原发性化疗乳腺癌患者细胞学证实腋窝淋巴结转移的发生率和预后意义。患者和方法：在1985年1月至1994年12月期间，152名乳腺癌患者患有浸润性T1至T3肿瘤和腋窝转移，经细针取样细胞学证实，接受了原发性化疗，随后进行了乳房肿瘤切除术或乳房切除术，I级和II级腋窝淋巴结清扫和照射。我们研究了病理完全反应（pCRs）的腋窝淋巴结和乳腺肿瘤，以及预测远处transferation.Results：35例（23%）腋窝pCRs，20例（13.2%）原发性乳腺肿瘤的pCRs。Scarff-Bloom-Richardson 3级肿瘤（P = 0.04）和化疗临床反应大于或等于50%（P = 0.003）与腋窝淋巴结清扫阴性相关。初始肿瘤大小小于或等于3 cm（63例患者）与原发肿瘤的pCR相关（P = 0.02），但与腋窝淋巴结的完全组织学清除无关。中位随访时间为75个月。在单变量分析中，年龄大于40岁（P = 0.003）、无残留淋巴结疾病（P = 0.01）和肿瘤的pCR（P = 0.05）与较好的无远处转移生存率相关。在手术时无淋巴结受累的患者中，5年无远处转移生存率为73.5% ± 14.9%，在有淋巴结残留疾病的患者中，5年无远处转移生存率为48.7% ± 9.2%。在多变量考克斯回归分析中，与无远处转移生存率差相关的参数是年龄小于或等于40岁（P = 0.002）、淋巴结持续受累（P = 0.03）和S期分数大于4%（P = 0.02）。结论：我们的研究结果表明，腋窝状况是一个比原发肿瘤对原发化疗反应更好的预后因素。(C)2002年，美国临床肿瘤学会。
Purpose: To determine the incidence and prognostic significance of eradication of cytologically proven axiilary lymph node metastases in breast cancer patients treated with primary chemotherapy.Patients and Methods: Between January 1985 and December 1994, 152 breast cancer patients with invasive T1 to T3 tumors and axillary metastases cytologically proven by fine-needle sampling underwent primary chemotherapy followed by lumpectomy or mastectomy, level I and II axillary lymph node dissection, and irradiation. We studied pathologic complete responses (pCRs) of axillary nodes and breast tumors, as well as predictors of distant metastases.Results: Thirty-five patients (23%) had axillary pCRs, and 20 patients (13.2%) had pCRs of primary breast tumors. Scarff-Bloom-Richardson grade 3 tumors (P = .04) and a clinical response to chemotherapy greater than or equal to 50% (P = .003) were associated with negative axillary status at dissection. An initial tumor size less than or equal to 3 cm (63 patients) was associated with pCR of the primary tumor (P = .02) but not with complete histologic clearance of axillary lymph nodes. The median length of follow-up was 75 months. In the univariate analysis, age greater than 40 years (P = .003), absence of residual nodal disease (P = .01), and pCR of the tumor (P = .05) were associated with better distant disease-free survival. Five-year distant disease-free survival rates were 73.5% +/- 14.9% among patients with no involved nodes at the time of surgery and 48.7% +/- 9.2% among patients with residual nodal disease. in the multivariate Cox regression analysis, parameters associated with poor distant disease-free survival were age less than or equal to 40 years (P = .002), persistence of nodal involvement (P = .03), and S-phase fraction greater than 4% (P = .02).Conclusion: Our results suggest that axillary status is a better prognostic factor than response of the primary tumor to primary chemotherapy. (C) 2002 by American Society of Clinical Oncology.